Abstract
Assessment of the left ventricular ejection fraction (LVEF) is important in patients admitted with myocardial infarction as a decreased LVEF is an indicator of poor prognosis. However, early measurement of LVEF can be misleading as patients can show delayed recovery of LVEF. Limited evidence exists regarding the use of predictors of LVEF recovery in patients with ST-elevation myocardial infarction (STEMI). Our aim was to determine if a lower level of cardiac biomarkers and electrocardiographic resolution of the ST elevation (ST–segment resolution of >50%) predicted LVEF recovery in patients with STEMI. We included patients admitted with STEMI to Einstein Medical Center from 2006 to 2008, with an LVEF of <50% during that admission, and a follow-up echocardiogram between 1 to 6 months after the event. A retrospective chart review was performed and 59 patients who underwent reperfusion therapy were included. Patients were identified as having recovery of myocardial function if the LVEF improved ≥ 10% (absolute value) on the subsequent echocardiogram. Both groups (improvement vs. non-improvement) had similar baseline characteristics. Mean age was 62. Forty percent were female, 71% were hypertensive and 46% were diabetic. Predictors of LVEF improvement were absence of dyslipidemia (p=0.01), resolution of the STsegment elevation (p=0.04) and lower troponin levels (highest quartile vs. other 3 quartiles p=0.04). Furthermore, one year mortality was higher in the group that had no LVEF improvement compared to the group with LVEF improvement (26% vs. 0). In conclusion, in patients with STEMI, ST-segment resolution and a lower peak troponin level accurately predicted LVEF recovery 1 to 6 months after the event. If the LVEF improved ≥ 10%, the one year mortality was negligible.
Highlights
Measurement of left ventricular systolic function has been widely accepted as a primary method of risk stratifying patients after STelevation myocardial infarction (STEMI)
Patients who died during the admission (24 patients), who had an ejection fraction (EF) >50% during hospitalization (115 patients), who did not have assessment of left ventricular ejection fraction (LVEF) during the admission and who did not have a follow up echocardiogram between one and six months after the STEMI (65 patients) were excluded
Assessment of left ventricular function has become one of the core performance measures for patients admitted with acute myocardial infarction [5]
Summary
Measurement of left ventricular systolic function has been widely accepted as a primary method of risk stratifying patients after STelevation myocardial infarction (STEMI). Left ventricular systolic function is predictive of early and late complications and mortality in these patients [1,2,3,4]. To further emphasize this important measurement, recently published guidelines by the American College of Cardiology/ American Heart Association (ACC/AHA) have included the evaluation of left ventricular systolic function as a performance measure for all patients admitted with acute myocardial infarction [5]. A study performed in 2001 showed that 90 days after a myocardial infarction treated with reperfusion therapy 22% of patients had complete recovery of left ventricular systolic function and an additional 36% had partial recovery. The majority of functional improvement occurred in the first 14 days [6,7] The only significant predictor of left ventricular systolic function recovery was a lower CK-MB peak level
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